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MLTC Quality Work Group Discusses 2018 and 2019 Quality Incentive Changes

Minor modifications will be made in the 2018 and 2019 Managed Long Term Care (MLTC) Quality Incentive, the Department of Health (DOH) announced in a recent meeting of the MLTC Quality Work Group. Performance on the measures included in the MLTC Quality Incentive drives the annual ratings of MLTC plans and the distribution of $141.5 million in MLTC quality pool funding. Pool distributions and ratings are based on four categories of measures: Quality, Satisfaction, Compliance, and Efficiency.

For 2018, the Department has decided to exclude one quality measure – the Percentage of Members Who Did Not Have an Emergency Room Visit in the Last 90 Days – due to inconsistent guidance in the Uniform Assessment System (UAS) regarding the location of the relevant data. Nine quality measures remain, including a new quality measure introduced in 2018: Percentage of Members Who Did Not Experience a Fall that Resulted in Major or Minor Injury in the Last 90 Days. Other quality measures relate to indicators of member health and functional status such as urinary continence, mood, pain, Nursing Facility Level of Care score, and health care process indicators such as flu immunizations and advance care planning conversations.

In addition to excluding the Emergency Room Visit measure, the Department has eliminated one compliance measure for 2018: a measure that compares encounter data to cost report data to evaluate the accuracy of the data. The data needed to create this measure was not ready in time for the 2018 quality pool distributions. Other compliance measures relate to the submission and completeness of provider network data, cost reports, encounter data, and assessments.

As a result of the exclusion of the two measures (i.e., Emergency Room Visits and Encounter-Cost Report Data Comparison), the total number of base points used when calculating the Quality Incentive was adjusted downward from 100 to 93.

There will also be a change in the data used to measure the Potentially Avoidable Hospitalization (PAH) measure for 2018. Due to the migration of the Statewide Planning and Research Cooperative System (SPARCS) hospital discharge intake system to a new technology platform, the July through December 2017 data is unavailable. Instead, the Department will use January through June 2017 hospital discharge data to develop the PAH scores. To identify the MLTC plans and the providers that serve the patients identified in the SPARCS data, the Department will use October 2016 through June 2017 UAS community health assessment data instead of April 2017 through December 2017 data.

As a result of this change, 2019 value-based payment (VBP) contracts between MLTC plans and providers will require a different baseline period for performance measurement. Instead of July through December 2017, the baseline should be January through June 2017.

In 2019, the Department intends to implement the Emergency Room Visit measure and the Encounter-Cost Report Data Comparison measure. In addition, the Department is proposing a new compliance measure based on the issuance of statements of deficiency in the prior year for failure to comply with Performance Improvement Project submission deadlines. Satisfaction measures in 2019 will be based on a survey to be conducted in early 2019.

The Department has released the final January-June 2017 PAH rates to providers and plans. Requests for final results of other MLTC VBP Category 1 measures at a provider level for the July-December 2016 or January-June 2017 period should be submitted here. July through December 2017 MLTC data is available on Health Data NY, with January through June 2018 MLTC data to be available soon.

The Department is seeking comments on these changes and any measures that should be added or dropped from the MLTC Quality Incentive. Comments should be submitted here.

Last week, MLTC plans received preliminary results of the 2018 MLTC Quality Report that will be finalized and made public. DOH has asked plans to review their preliminary results along with the MEDS III, Provider Network, and MMCOR Statement of Deficiency data (distributed with Crude Percentage Reports on Nov. 30th) and notify DOH by Dec. 15th of any questions, comments, or corrections. Please note that this is an opportunity to review and verify that the data used by DOH in the report reflects the information submitted by your organization. It is not an opportunity to change or update your data submission. Questions and comments should be submitted here.

The slides from the MLTC Quality Work Group meeting are available here.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124